Anxiety to Empowerment: Pre-Client Application

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* 1. First, tell me a bit about yourself!

First & Last Name

What do you do for work?

Where do you live?

What's the best email to reach you at?

What's your phone number?

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* 2. Please confirm that you understand Amanda does not work with high school or college students in a 1:1 capacity. If you are in high school or college, feel free to continue the survey and a member of our team will follow up with available opportunities.

I am not in high school or college and am of legal age

I am still in high school or college but am interested in other course offerings

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* 3. Rank in order (high to low priority) what is currently drawing you to explore Anxiety to Empowerment coaching

I want to deepen my spiritual practices

I want to learn how to manifest my dream life

I want to shift my relationship with my anxiety, self-doubt, and fear

I desire to generate more personal empowerment

I feel generally lost and don't know where to start

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* 4. Based off of your response to Q2, please describe what you're looking for in greater detail.

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* 5. What currently triggers your anxiety/self doubt the most?

Work ("I'm unhappy with my job and don't know what's next.")

Relationships ("The relationships in my life are unfulfilling.")

Relationship to self ("I feel like I'm just going through the motions, not experiencing my life")

Time ("I'm always run down/busy")

Other

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* 6. What is currently your biggest blocker, obstacle, or fear point?

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* 7. How do you WANT to feel in the next 6-12 months?

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* 8. Rank your committment to creating change in your life

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* 9. Why do you believe working with a coach is required at this level of your expansion?

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* 10. On a scale of 1 - 10 (with 10 being the MOST ready), how ready are you to invest in your growth?

Clear

i We adjusted the number you entered based on the slider’s scale.

Anxiety to Empowerment: Pre-Client Application

Question Title

* 1. First, tell me a bit about yourself!

Question Title

* 2. Please confirm that you understand Amanda does not work with high school or college students in a 1:1 capacity. If you *are* in high school or college, feel free to continue the survey and a member of our team will follow up with available opportunities.

Question Title

* 3. Rank in order (high to low priority) what is currently drawing you to explore Anxiety to Empowerment coaching

Question Title

* 4. Based off of your response to Q2, please describe what you're looking for in greater detail.

Question Title

* 5. What currently triggers your anxiety/self doubt the most?

Question Title

* 6. What is currently your biggest blocker, obstacle, or fear point?

Question Title

* 7. How do you WANT to feel in the next 6-12 months?

Question Title

* 8. Rank your committment to creating change in your life

Question Title

* 9. Why do you believe working with a coach is required at this level of your expansion?

Question Title

* 10. On a scale of 1 - 10 (with 10 being the MOST ready), how ready are you to invest in your growth?

* 2. Please confirm that you understand Amanda does not work with high school or college students in a 1:1 capacity. If you are in high school or college, feel free to continue the survey and a member of our team will follow up with available opportunities.